BY: BRITTANY COXEPIDEMIOLOGY OF CHRONIC DISEASES

Asthma

Asthma Definition

Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted People with asthma have oversensitive airways that

react strongly to allergens and when exposed to triggers, the immune system kicks into overdrive and closes off the airways, making it difficult to breathe

The most common long-term diseases of children Can occur in adults also

Causes are unknown

How Can You Tell if You Have Asthma?

Doctor administer a breathing test called spirometry Measure how well your lungs are working Computer with a mouthpiece to test how much air

you can breathe out after taking a very deep breath The spirometer can measure airflow before and after the

use asthma medication 

During a checkup the doctor will ask: Cough a lot, especially at night Breathing problems are worse after physical activity

or at certain times of year Family history

Risk Factors

GenderObesitySmokingSocio-economic statusLiving in urban environmentsGeographical location

Asthma Triggers

Common asthma triggers include: Animals (pet hair or dander) Dust mites Certain medicines (aspirin and other NSAIDS) Changes in weather (most often cold weather) Chemicals in the air or in food Exercise Mold Pollen Respiratory infections, such as the common cold Stress Tobacco smoke

Many people with asthma have a personal or family history of allergies or eczema

Asthma Symptoms

Symptoms of asthma include: Wheezing Coughing, especially early in the morning or at night Chest tightness Shortness of breath

Other symptoms that may occur: Abnormal breathing pattern

--breathing out takes more than twice as long as breathing in

Breathing temporarily stops Chest pain

Emergency Asthma Symptoms

Emergency symptoms that need prompt medical assistance: Bluish color to the lips and face Decreased level of alertness, such as severe

drowsiness or confusion, during an asthma attack Extreme difficulty breathing Rapid pulse Severe anxiety due to shortness of breath Sweating

What Is an Asthma Attack?

The attack happens in the body’s airwaysDuring an asthma attack:

The sides of the airways in the lungs swell and the airways shrink

Less air gets in and out of the lungs, Mucus production is increased and clogs up the

airways Muscles of the bronchial tree become tight and the

lining of the air passages swells Reducing airflow and producing the characteristic

wheezing sound

Complications

The complications of asthma can be severe, and may include: Death Decreased ability to exercise and take part in

other activities Lack of sleep due to nighttime symptoms Permanent changes in the function of the lungs Persistent cough Trouble breathing that requires breathing

assistance (ventilator)

Treatment

Follow doctor's instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms.

There are two kinds of medicines for treating asthma: Control medicines to help prevent attacks Quick-relief (rescue) medicines for use during

attacks

Control Medicines

Long-term Medicines or controller medicines are used to prevent symptoms in people with moderate to severe asthma Must take them every day for them to work

Some are breathed in (inhaled), such as steroids and long-acting beta-agonists

Others are taken by mouth (oral)

Quick-relief Medicines

Also called rescue medicinesThey are taken for:

Coughing, wheezing, trouble breathing, or an asthma attack

Just before exercising to help prevent asthma symptoms caused by exercise.

Quick-relief medicines include: Short-acting inhaled bronchodilators Oral corticosteroids for when an asthma attack does

not go away

Peak Flow Meter

A simple device to measure how quickly you can move air out of your lungs

It can help regulate if an attack is coming, sometimes even before symptoms appear

Peak flow measurements help let you know when medicine or other action needs to be taken

Peak flow values of 50% - 80% of your best results are a sign of a moderate asthma attack

Numbers below 50% are a sign of a severe attack

Prevalence

Every day in America: 44,000 people have an asthma attack 36,000 kids miss school due to asthma 27,000 adults miss work due to asthma 4,700 people visit the emergency room due to asthma 1,200 people are admitted to the hospital due to

asthma 9 people die from asthma

Geographic Distribution

Asthma prevalence: Northeast (8.1%) Midwest (7.5%) West (6.8%) South (6.7%)

Emergency department visit rate estimates: Northeast (10.4 per 100 persons with current asthma) South (9.6 per 100 persons with current asthma) Midwest (8.7 per 100 persons with current asthma) West (6.7 per 100 persons with current asthma)

Asthma is increasing every year in the US

The number of people with asthma continues to grow One in 12 people (about 25 million, or 8% of the population) had

asthma in 2009 Compared with 1 in 14 (about 20 million, or 7%) in 2001

More than half (53%) of people with asthma had an asthma attack in 2008 More children (57%) than adults (51%) had an attack

185 children and 3,262 adults died from asthma in 2007 About 1 in 10 children (10%) had asthma and 1 in 12 adults

(8%) had asthma in 2009. Women were more likely than men and boys more likely than girls to have asthma.

About 1 in 9 (11%) non-Hispanic blacks of all ages and about 1 in 6 (17%) of non-Hispanic black children had asthma in 2009 The highest rate among racial/ethnic groups.

The greatest rise in asthma rates was among black children (almost a 50% increase) from 2001 through 2009

Cost

Asthma has a high cost for individuals and the nation Asthma cost the US about $3,300 per person with asthma each

year from 2002 to 2007 in medical expenses Medical expenses associated with asthma increased from $48.6

billion in 2002 to $50.1 billion in 2007 About 2 in 5 (40%) uninsured people with asthma could not

afford their prescription medicines About 1 in 9 (11%) insured people with asthma could not afford

their prescription medicines More than half (59%) of children and one-third (33%) of adults

who had an asthma attack missed school or work because of asthma in 2008

On average, in 2008 children missed 4 days of school and adults missed 5 days of work because of asthma

Who isn’t getting the care they need because of the cost?

Effective asthma care can be expensive Difficult for people to get the care

In many cases, private and public healthcare programs ensure that children receive care Therefore, adults are less likely to receive the care they need when cost is

an issueMany ethnic and racial minorities struggle to pay for the

medicines they need: More than 1 in 4 black adults can’t afford their asthma medicines 1 in 5 Hispanic adults can’t afford their asthma medicines

Although doctors are an important part of effective asthma management, many ethnic and racial minorities don’t see a doctor regularly as part of their asthma care: More than 1 in 4 black adults can’t afford routine doctor visits Nearly 1 in 7 Hispanic adults can’t afford routine doctor visits.

Prevention

Reduce asthma symptoms by avoiding triggers and substances that irritate the airways

Cover bedding with allergy-proof casings to reduce exposure to dust mites

Remove carpets from bedrooms and vacuum regularly

Use only unscented detergents and cleaning materials in the home

Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold

Prevention cont.

Keep the house clean and keep food in containers and out of bedrooms This helps reduce the possibility of cockroaches Body parts and droppings from cockroaches can trigger asthma

attacks in some peopleIf a person is allergic to an animal that cannot be

removed from the home, the animal should be kept out of the bedroom

Place filtering material over the heating outlets to trap animal dander

Change the filter in furnaces and air conditioners oftenEliminate tobacco smoke from the homeAvoid air pollution, industrial dust, and irritating fumes

Types of Asthma

Occupational AsthmaChildhood AsthmaExercise-Induced AsthmaCough-Variant Asthma

 Allergic Asthma

People with a family history of allergies or asthma are more prone to developing asthma

Many people with asthma also have allergies Most common form of asthmaTriggered by inhaling allergens

Occupational Asthma

Caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job

Irritants in high doses that induce occupational asthma include: Hydrochloric acid Sulfur dioxide Ammonia

Which is found in the petroleum or chemical industries

If exposed to any of these substances at high concentrations, may begin experiencing asthma symptoms immediately after exposure

Childhood Asthma 

Impacts millions of children and their familiesThe majority of children who develop asthma

do so before the age of five The most common serious chronic disease in

infants and children; yet is often difficult to diagnose

Exercise-Induced Asthma

Type of asthma triggered by exercise or physical exertion

Many people with asthma experience some degree of symptoms with exercise Some without asthma can develop symptoms only during exercise

Airway narrowing peaks five to 20 minutes after exercise begins, making it difficult to catch your breath

Symptoms of an asthma attack such as wheezing and coughing make occur

An asthma inhaler can be used before exercise to prevent asthma symptoms

Cough-Variant Asthma

Type of asthma where severe coughing is the predominant symptom

There can be other causes of cough such as postnasal drip, chronic rhinitis, sinusitis, or heartburn

Coughing because of sinusitis with asthma is commonVastly underdiagnosed and undertreatedAsthma triggers for cough-variant asthma are usually

respiratory infections and exerciseThe doctor may order specific asthma tests, such as lung

function tests, to show how well the lungs workVisit a lung specialist for further tests before an

asthma diagnosis can be made

International Prevalence

The prevalence of asthma in different countries varies widely But the disparity is narrowing due to rising prevalence in low and

middle income countries and plateauing in high income countriesAn estimated 300 million people worldwide suffer from

asthma With approximately 250,000 annual deaths attributed to the disease

Almost all of these deaths are avoidable It is estimated that the number of people with asthma will grow by

more than 100 million by 2025Workplace conditions, such as exposure to fumes, gases or

dust, are responsible for 11% of asthma cases worldwide

 

What can be done

Federal, state, and local health officials can: Track asthma rates and the effectiveness of control

measures so continuous improvements can be made in prevention efforts

Promote influenza and pneumonia vaccination for people with asthma

Promote improvements in indoor air quality for people with asthma through measures such as smoke-free air laws and policies, healthy schools and workplaces, and improvements in outdoor air quality

What can be done cont.

Health care providers can: Determine the severity of asthma and monitor how

much control the patient has over it Make an asthma action plan for patients

Use this to teach them how to use inhaled and other prescribed medicines correctly and how to avoid asthma triggers such as tobacco smoke, mold, pet dander, and outdoor air pollution

Prescribe inhaled corticosteroids for all patients with persistent asthma

What can be done cont.

Schools and school nurses can: Use student asthma action plans to guide use of

inhaled corticosteroids and other prescribed asthma medicines correctly and to avoid asthma triggers

Make students' quick-relief inhalers readily available for them to use at school as needed

Take steps to fix indoor air quality problems like mold

What can be done cont.

Employers and insurers can: Promote healthy workplaces by reducing or

eliminating known asthma triggers Promote measures that prevent asthma attacks such

as eliminating co-payments for inhaled corticosteroids and other prescribed medicines

Provide reimbursement for educational sessions conducted by clinicians, health educators, and other health professionals both within and outside of the clinical setting

Provide reimbursement for long-term control medicines, education, and services to reduce asthma triggers that are often not covered by health insurers

Future Research

Further work to develop appropriate animal models for asthma research is needed

More data on long-term side effects of asthma medication

Cost effectiveness of avoidance of asthma triggers

Development of better treatment options

National Institute of Allergy and Infectious Diseases (NIAID)

Current basic, preclinical, and clinical research aims to: Investigate the role of the immune system in the

development, treatment, and prevention of asthma Understand the role that environmental allergens and

pollution may play in the development and worsening of asthma

Improve current treatments and develop new ones that reduce or eliminate the response of the immune system to environmental allergens that trigger asthma

National Asthma Control Program

CDC’s National Asthma Control Program helps Americans with asthma achieve better health and improved quality of life and to reduce the overall hardship that asthma puts on the workforce, healthcare system, and communities A resource for people with asthma Collect information and follow trends related to asthma Share our knowledge with the programs we support and the

asthma community Fund programs to create localized efforts to assist people with

asthma Study the impact of asthma programs and treatment measures Use what we learn to re-invest in strategies that will help

Americans with asthma

COPD Definition

Chronic Obstructive Pulmonary Disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems

It includes emphysema, chronic bronchitis, and in some cases asthma

Types of COPD

There are two main forms of COPD: Chronic bronchitis

Which involves a long-term cough with mucus Emphysema

Which involves destruction of the lungs over time

Most people with COPD have a combination of both conditions

Diagnosis of COPD

The list of diagnostic tests used in the diagnosis of COPDincludes: Spirometer (lung function test) Forced vital capacity (FVC) lung test Residual volume (RV) lung test Total lung capacity (TLC) lung test Diffusing capacity lung test

Risk Factors

In the United States, tobacco smoke is a key risk factor in the development and progression of COPD Although exposure to air pollutants in the home and

workplace, genetic factors, and respiratory infections also play a role

In the developing world, indoor air quality is thought to play a larger role in the development and progression of COPD than it does in the United States

Symptoms

Chronic cough (also known as smoker’s cough)

Chronic phlegm productionShortness of breath while doing things you

used to be able to doNot being able to take a deep breathWheezing

Prevalence

The third leading cause of death in the United States in 201115 million Americans report that they have been diagnosed

with COPDMore than 50% of adults with low pulmonary function were

not aware that they had COPD Therefore the actual number may be higher

The following groups were more likely to report COPD: People aged 65–74 years Non-Hispanic whites Women Individuals who were unemployed, retired, or unable to work Individuals with less than a high school education People with lower incomes Individuals who were divorced, widowed, or separated Current or former smokers Those with a history of asthma

Prevention

Avoid inhaling tobacco smoke, home and workplace air pollutants, and respiratory infections to prevent developing COPD

Early detection of COPD might change its course and progress

A spirometry can be used to measure pulmonary or lung function and detect COPD in anyone with breathing problems

Treatment

There is no cure for COPD Treatment is available to manage the symptoms and improve quality of life

Treatment of COPD requires a careful and thorough evaluation by a physician

COPD treatment can: Alleviate symptoms Decrease the frequency and severity of exacerbations Increase exercise tolerance

For those who smoke, the most important aspect of treatment is smoking treatment options include: Medication (such as inhalers) Pulmonary rehabilitation Physical activity training Oxygen treatment

Pulmonary rehabilitation is an individualized treatment program that teaches COPD management strategies to increase quality of life Plans may include:

Breathing strategies, energy-conserving techniques, and nutritional counseling

Medications used to treat COPD

Inhalers (bronchodilators) to open the airways ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Sereve

nt),formoterol (Foradil), or albuterolInhaled steroids to reduce lung inflammationAnti-inflammatory medications

 montelukast (Singulair) and roflimulast are sometimes usedIn severe cases or during flare-ups, may need to

receive: Steroids by mouth or through a vein (intravenously) Bronchodilators through a nebulizer Oxygen therapy Assistance during breathing from a machine (through a mask,

BiPAP, or endotracheal tube)Antibiotics are prescribed during symptom flare-ups,

because infections can make COPD worse

Complication of COPD

Heart failurePulmonary hypertensionPolycythemiaDeath